Pelvic floor exercises

Pelvic floor muscles stretch from pubic bone in front to the base of spine at back

  • Support pelvic organs — bladder, uterus, bowel

  • Help control 3 openings in pelvic floor — urethra, vagina and anus

Strong pelvic floor muscles are important in

  • Pregnancy — firm pelvic floor supports pregnant uterus. Pelvic floor exercises help recovery after birth
  • Urine control — pelvic floor muscles weaken after having babies and getting older. Can become incontinent
  • Pelvic floor exercises can help prevent and/or control
    • Stress incontinence (losing urine when coughing, sneezing, exercising)
    • Urge incontinence (urgent need to pass urine). Urge incontinence also needs bladder training
    • Faeces control
    • Pelvic organ prolapse — pelvic floor exercises can improve associated symptoms
  • During sex — good vaginal muscle tone may increase enjoyment for woman and partner

Pelvic floor muscles can be weakened by

  • Pregnancy and birth
  • Constipation and straining
  • Hormone changes at menopause
  • Being overweight, not enough exercise/prolonged immobility
  • Constant heavy lifting
  • Chronic cough (eg smoker’s cough)
  • Ageing and loss of muscle tone

Talk with woman about

  • Pelvic floor muscles — function and importance and need to exercise them
  • Healthy lifestyle — healthy food, drinking enough water, physical activity (especially walking), healthy weight
  • Stopping smoking — smokers more likely to develop chronic cough. Coughing puts extra pressure on weak pelvic floor
  • Teach woman to identify pelvic floor muscles
    • Use drawings and models to explain, if available — Figure 6.21

Figure 6.21   
  • If clinician skilled and woman consents — can help women identify muscles during vaginal exam. Ask her to try and squeeze and lift around your fingers. Vagina should tighten around your fingers. Encourage multiple attempts with verbal feedback. ​If woman not comfortable with idea of vaginal exam she can check pelvic floor herself using her own fingers. Talk about how to identify muscles

Ask woman to

  • Stop dribble of urine at end of urination, feel which muscles tighten. Once she knows correct muscles, caution that repeating too often may interfere with normal bladder emptying
  • Tighten ring of muscles around her anus as if she is trying to control wind but not to tighten her buttocks, hips or thighs
  • Tighten and draw in muscles around anus, vagina, urethra at same time. Woman should feel as though she is lifting them up inside her
  • Do 10 sets with rests in between each set (20 squeezes of the muscles) twice or even three times every day (40-60 squeezes each day)
  • Increase hold each week by 1 second as able, up to 10 seconds
  • If poor numeracy consider suggesting exercises for period of time (5 minutes) resting between each set and if the muscles feel tired
  • Fast exercises — do 2 short strong and fast contractions (muscle tightenings). Increase gradually to 10 contractions as able
  • Start doing exercises lying down with knees bent to identify right muscles. Then can do exercises while lying, sitting, standing
  • Encourage woman to do both fast and slow exercises 3 times a day
  • May be useful to link with regular habits to help remember to do exercises — when waking up and going to sleep, taking medicines, meal times
  • If treating urinary incontinence
    • Maximum benefit achieved by 3 months of 10 x 10 second holds
    • Medical consult if ongoing problems

Supporting resources

  • Pelvic floor muscles video
  • Female pelvic floor incontinence video (Warlpiri)